BPH and ED pharm Flashcards
drugs that can exacerbate BPH
antihistamines TCAs phenothiazines anticholinergics testosterone alpha agonists
alpha adrenergic blockers treat ____
BPH
alpha adrenergic blockers affect on bladder
relax the urethra and reduce smooth muscle contractions in the prostate
alpha adrenergic blockers onset
rapid onset and immediate relief of symptoms
alpha adrenergic blockers adverse effects
dizziness
orthostatic hypotension
syncope
retrograde ejaculation
can cause intraoperative floppy iris syndrome during cataract surgery
alpha adrenergic blockers
what is intraoperative floppy iris syndrome
a complication of cataract surgery that can occur while taking alpha adrenergic blockers.
iris prolapse through surgical incision
how to initiate therapy with alpha adrenergic blockers
titrate dose over several weeks to minimize side effects
take first dose at bedtime
beware drug interactions
CYP3A4 inducers that increase metabolism of alpha blockers
carbamazepine
phenytoin
rifampin
CYP3A4 inhibitors that increase serum concentration of alpha blockers
ketoconazole
ritonavir
itraconazole
avoid this rx until after cataract surgery
alpha blockers
5a reductase inhibitors
finasteride
dutasteride
5a reductase inhibitors MOA
inhibition of 5alpha reductase prevents conversion of testosterone to DHT which decreases prostate growth and provides obstruction relief over time
does not immediately relieve LUTS
5a reductase inhibitors
use for pts with large prostate volume (>40g)
5a reductase inhibitors
5a reductase inhibitors adverse effects
decreased libido ED gynecomastia decreases serum PSA by 50% preggos should not touch semen
reduces prostate related hematuria
finasteride
can decrease serum PSA by 50%
5a reductase inhibitors
which 5a reductase inhibitor is a CY3A4 inhibitor?
dutasteride
what should you tell a patient taking 5a reductase inhibitor?
emphasize adherence (d/c may cause relapse) and that rx may take 6 months to see effect
which BPH rx stops disease progression?
5a reductase inhibitors
which BPH has cardiovascular adverse effects
a blockers
when should you use combination 5a reductase inhibitor and alpha blocker?
in pts with irritative LUTS and prostate enlargement
phosphodiesterase-5 inhibitors
tadalafil (cialis)
sildenafil (viagra)
vardenafil (levitra)
phosphodiesterase-5 inhibitors MOA
inhibits PDE5 in bladder prostate and urethra, increase NO vasodilation
increases cGMP and increases smooth muscle relaxation
desired effect of phosphodiesterase-5 inhibitors
increased blood flow in corpus cavernous to increase penis size during erection
erectile dysfunction causes
PENIS Psychological, Endocrine, Neurogenic, Insufficient blood flow, Substance use.
erectile dysfunction
consistent inability to gain/maintain penile erection with sufficient rigidity for intercourse
not a symptom of aging
what leads to prolonged erection
after penis swells and elongates, the corporal tissue compresses venues to decease outflow and prolong erection
PDE-5 inhibitors ____ PDE5 which____cGMP and ____ NO vasodilation leading to ______
inhibit
increases
increases
prolonged erection
PDE5 contraindications
nitrates due to risk of hypotension
CVD
PDE5 adverse effects
headache dizziness
flushing
dyspepsia
visual disturbance
rare side effects from PDE5 inhibitors
hearing loss
priapism
optic neuropathy
what should a pt taking PDE5 inhibitor and alpha blocker be counseled on?
take alpha blocker 4 hours apart to avoid orthostatic hypotension
T replacement
low testosterone
hypogonadism causing ED
contraindicated for T replacement
prostate cancer breast cancer LUTS erythrocytosis (Hct>50%) sleep apnea HF
testosterone patient counseling
wash hands after application
allow area to dry, do not get area wet for 5 hours
alprostadil
prostaglandin that enhances smooth muscle relaxation resulting in filling of corpora and erection
alprostadil pt counseling
first application done in office to see technique
may have some bleeding
burning can be alleviated by a little rubbing!
non-pharm ED treatment
reduce alcohol, smoking, drugs
vacuum devices
surgical devices
